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General NPI Number Information
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NPI Number | 1154816064
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Entity Type | Individual
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Provider Name | WILLIAM ANTON WANNINGER DMD
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 2636 HIGHWAY 17A S STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29483-9114
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Country | US
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Telephone | 843-242-0645
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 THIN PINE DR
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City | JOHNS ISLAND
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State | SC
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Zip | 29455-8796
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Country | US
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Telephone | 205-369-3424
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10460
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License Number State | SC
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